Shin splints, often referred to as tibialis anterior pain or medial tibial stress syndrome (MTSS), are common in people like runners and athletes in high-impact sports—although they can impact anyone. Here, we’ll talk about what shin splints are and how they’re treated, as well as answering questions like:
What are shin splints?
Shin splints are not actually identical to MTSS, but the two conditions are closely related.
Typically, what we refer to as shin splints is a collection of different symptoms in the lower leg that come in two different forms. With MTSS, pain occurs on the medial, or inside, of your shin, where the bone is—also called posterior shin splints. Symptoms can also occur on the front and outside region of the shin, over your muscles, referred to as anterior shin splints.
What do shin splints feel like?
When you’re experiencing posterior shin splints—shin pain on the interior side of your shins—it usually presents as an achy feeling along the bones, and can feel a bit sharp at times. When you’re experiencing anterior shin splints, on the front and outside of your shins over the muscles, a similar feeling of achiness is usually present, along with a tension and pressure.
What’s the difference between a shin splint and a stress fracture?
Both shin splints and stress fractures are common overuse injuries. However, with stress fractures, the injury comes from cumulative and repeated strain on the bone, causing it to weaken and get a tiny crack or group of cracks, known as stress fractures. With shin splints, pain tends to occur over a broad area, while with a stress fracture, it’s in a smaller location and gets worse as you continue an activity such as running.
Who gets shin splints?
Usually, shin splints are experienced by people who are either active or becoming active again—often, someone who has had some sort of significant change in their activity level, intensity and duration. Shin pain from running is really common. We also often see shin splints in people who are playing higher-impact sports like basketball, ultimate frisbee, soccer, football or rugby.
For example, a soccer player who hasn’t played all winter and then starts running, or someone who switches footwear, such as a soccer player going from wearing running shoes to wearing cleats. There’s a common misconception about footwear that shoes can get old and cause problems. Shoes actually last a lot longer than we think so it’s not necessarily a problem of the shoe getting old, it’s the notable change in footwear that can trigger shin splints.
A history of related injuries is also incredibly common as a contributing factor to shin splints: in particular, injuries that impact the foot and ankle such as old ankle sprains, plantar fasciitis, toe injuries, heel issues and calf strains. This is because of the proximity of these areas to the shins, and how your body compensates over time, whether it’s a traumatic injury or something that has built up. Keep reading to find out more about the causes of shin splints.
What causes shin splints?
A lot of the causes of shin splints are biomechanical, relating to the way you move. For example, think about the way we run. The most optimal, efficient way for us to move is to run where our foot runs flat or a little more biased to the ball of our foot. Those who tend to land a little bit more on their heel are going to end up with more stress on both the inside and outside of the shin. When we land on the ball of our foot or flat on our foot, our foot and ankle can help absorb some of the stresses of our running. In comparison, when we land straight on the heel, the forces go instantly up through the shin bone, which impacts both the muscles that need to stabilize the ankle and also the soft tissues along the shin itself.
Another contributing factor to altered biomechanics is calf or posterior chain weakness. Calf weakness, from an old injury or just from being under-developed relative to other areas or to the demands of the activity, is a problem because it shifts the way you move. Similar to the example above of the way your heel strikes, if there’s not enough strength in the calf to handle the forces hitting it, your body finds an alternate way to move and ends up putting stress on your shin.
As we mentioned above, a history of ankle issues is significant because it leads to instability and your ankle not being as able to absorb forces. There could also be muscle weakness, with those muscles being late to activate, causing stress to go through that whole region of your body.
Another contributing factor is having really stiff ankles, where if your foot stays flat you can’t really bring your knee very far forward relative to it. We call this dorsiflexion: the movement bringing your toes and ankle up toward your knee. With a stiff ankle, it doesn’t allow for the full mobility needed to properly absorb forces and distribute them evenly.
The biggest thing to remember is that the entire posterior chain is involved. When someone is overusing their hamstrings, their quads, their glutes, or even their back, they are more likely to experience shin splints.
What will be involved in a physical therapy session to treat medial tibial stress syndrome?
As with all our physiotherapy treatments, we first focus on addressing all the different contributing factors that are individual to you. We’ll look at the activities you’re doing, where imbalances are happening and what related injuries you may have.
We use a lot of electro-acupuncture with our clients, because it’s a great way to calm down nerve irritation, activate muscles and improve the mobility of the soft tissues around the foot, ankle and the entire leg.
With manual therapy, we work on things like mobility and restricted range of motion. We primarily focus on soft tissues, using our hands to improve mobility of the sole of the foot, or to improve calf or ankle stiffness. We also focus on things higher up the chain and related injuries that can be indicative of problems in the lower body.
We also use the RedCord treatment system. Here, cables suspended from the ceiling offload a portion of your body weight, helping improve and retrain your movement patterns. By isolating specific muscles through body weight exercises, we help you break compensation patterns and ensure your stabilizer muscles engage in the right way at the right time.
We also provide education and advice around exercise that will address the exact symptoms someone is experiencing, and the regions where they’re having problems. We alway make sure you’re progressing at an appropriate rate—adding exercises where needed, removing things if they’re not working, and making sure everything is helping you make the progress you ultimately want to achieve.
Are there any pain reduction strategies for shin splints?
One big self-care strategy you can do in the short term is using a massage ball, like a lacrosse ball or tennis ball, starting through the sole of the foot. A lot of times the plantar fascia, the tissues on the sole of the foot, can build up a lot of extra tension. Some of the muscles that stabilize the ankle actually attach down there, so this technique is a great way to help loosen that up and give us some relief and control of the foot and ankle.
As an acute management tool, you can do a little bit of rolling with a foam roller or a self-massage tool for the shin area, whether it’s along the inside or outside.
What are some corrective stretches and exercises you can do for shin splints?
Working on calf and ankle strengthening is really important. We usually recommend that people start with a single-leg balance like standing on one leg, standing on an unstable surface, or standing while doing something with one leg or with the upper body. This is a good way to work on control of the ankle if there’s any instability. From there, you can progress to more challenging movements such as single-leg hopping. The idea is to do movements that aren’t as intense as running or other athletic activities you’re participating in, but at the same time are building up your tolerance toward a more resilient foot, ankle and calf.
To strengthen your calves, you can also do single-leg raises and try going up onto your toes and back down. Try different versions as you progress: start on the ground, then do it on the stairs, going up as high as you can with your heel and then dropping down below the level of your foot. You can try doing it with a bit of a hop, or holding your calf raised for a longer period of time, varying in terms of duration, intensity and speed.
For ankle mobility, we recommend calf-stretching, for example up against a wall.
We also like to progress people to lunges, or what we refer to as split squats. It’s a way to engage the ankle and calf while pushing forward—a simulation of a running or jumping movement, but in a controlled environment. You can add weights or resistance to help build up strength beyond just using your body weight. It helps prepare your muscles for doing those running and jumping activities.
Any exercises that are more larger-muscle focused are good as well, such as single-leg deadlifts, a more complex, challenging movement that involves a combination of both single-leg balance and control with the entire posterior chain. As this is a bit more complex, it’s really important to make sure you’re doing it properly, something the therapists in our physiotherapy clinic are able to advise you on.
What are some tips for preventing shin splints?
Stretching through the ankle and calf is a good preventative exercise. We recommend doing a stretch where your knee is totally straight, and also one where your knee is bent, as this targets both higher and lower aspects of the calf. These are good things to be doing on a regular basis, as well as after any sort of activity.
One strategy we recommend is getting a cheap pair of soft insoles from a pharmacy. They don’t need to be fancy orthotics, just something that is soft and squishy and that you can put into your shoe. Think of it as a mini pillow that will help distribute forces a bit more evenly and absorb some of the impact related to the activity you’re doing.
A lot of times, shin splints happen because of some sort of change in activity—whether it’s changing footwear completely, or changing surfaces, like going from basketball on a court to basketball on concrete, or running on a trail vs running on a track or concrete. It’s important not to just jump in and start something new right away—you should give your body a bit more time to adjust and progress smoothly.
Can you still exercise with shin splints?
Rest is key in helping your body recover from shin splints. By modifying your exercise routine, and activities, you can continue to exercise, while not causing additional shin pain. If you were experiencing shin pain from running, cut back on the amount of time you spend running and wear compression socks, compression wraps or apply kinesiology tape to help prevent pain. Or, try lower-impact exercises while you recover, like biking or swimming.
Looking for a physiotherapy clinic in Toronto? Contact us at Endeavour to learn more and book your treatment.
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